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NPI Code Detail

MEDICARE: CHARLES B. WANG COMMUNITY HEALTH CENTER, INC.

MEDICARE: CHARLES B. WANG COMMUNITY HEALTH CENTER, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1333600000XPharmacy
23336C0003XCommunity/Retail Pharmacy

General Provider Information

NPI Number : 1477485894
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHARLES B. WANG COMMUNITY HEALTH CENTER, INC.
Provider Business Mailing Address
First Line : 268 CANAL STREET
Second Line :
City : NEW YORK
State : NY
Zip : 10013
Country : US
Telephone Number : 212-379-6988
Fax Number : 212-379-6936
Provider Business Practice Location Address
First Line : 131-72 40TH ROAD
Second Line :
City : FLUSHING
State : NY
Zip : 11354-5137
Country : US
Telephone Number : 718-587-1300
Fax Number :
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : MR. KAUSHAL CHALLA
Credential :
Telephone Number : 212-379-6988
Provider Enumeration Date : 06/01/2026
Last Update Date : 06/01/2026

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